Rossi B M, Nakagawa W T, Novaes P E, Filho W D, Lopes A
Department of Pelvic Surgery, A.C. Camargo Hospital, Antonio Prudente Foundation, São Paulo, Brazil.
Ann Surg Oncol. 1998 Mar;5(2):113-8. doi: 10.1007/BF02303843.
The objective of this prospective study was to determine the possibility of treatment based exclusively on chemotherapy and radiotherapy for patients with low infiltrative rectal tumors in an attempt to preserve sphincter function.
Sixteen patients with rectal adenocarcinoma up to 3 cm above the pectineal line with initial indications for abdominoperineal resection (APR) were submitted to a 5040-cGy (28 x 180 cGy) radiotherapy dose and chemotherapy during the first 3 and last 3 days of radiotherapy, using 425 mg/m2/day of 5-fluorouracil (5FU) and 20 mg/m2/day of folinic acid. Levamisole was used at 150 mg/day for 3 consecutive days at 2-week intervals throughout the period of therapy. Patients with a complete response were not submitted to APR, but received additional brachytherapy for curative purposes with doses from 2000 to 3000 cGy. Patients with recurrence after a complete response, with partial response, or with no response were submitted to APR.
Six patients (37.5%) presented a complete response, five (31.25%) presented a partial response, and five (31.35%) did not respond. The disease-free interval ranged from 1 to 34 months (mean = 11 months) among the six patients with complete response, and only one patient not submitted to APR is currently asymptomatic. Among the 15 patients with an indication for APR, three refused surgery because of full improvement of clinical symptoms and currently have tumor activity in the rectum. Mean patient follow-up was 23.8 months (8 to 43 months), and ten patients (62.5%) showed no evidence of active disease at last follow-up.
The therapeutic schedule used was not effective in preserving sphincter function in patients with low infiltrative rectal adenocarcinoma, because responses, although very frequent, were only temporary.
这项前瞻性研究的目的是确定仅通过化疗和放疗治疗低位浸润性直肠肿瘤患者以保留括约肌功能的可能性。
16例直肠腺癌患者，肿瘤位于耻骨线以上3 cm以内，最初有行经腹会阴联合切除术（APR）的指征，在放疗的前3天和最后3天接受5040 cGy（28×180 cGy）的放疗剂量及化疗，使用5-氟尿嘧啶（5FU）425 mg/m²/天和亚叶酸20 mg/m²/天。在整个治疗期间，左旋咪唑以150 mg/天连续服用3天，每2周重复一次。完全缓解的患者未接受APR，但为达到治愈目的接受了2000至3000 cGy的额外近距离放疗。完全缓解后复发、部分缓解或无反应的患者接受APR。
6例患者（37.5%）完全缓解，5例（31.25%）部分缓解，5例（31.35%）无反应。6例完全缓解的患者无病生存期为1至34个月（平均11个月），只有1例未接受APR的患者目前无症状。在15例有APR指征的患者中，3例因临床症状完全改善而拒绝手术，目前直肠有肿瘤活动。患者平均随访23.8个月（8至43个月），10例患者（62.5%）在最后一次随访时无疾病活动迹象。
所采用的治疗方案在保留低位浸润性直肠腺癌患者的括约肌功能方面无效，因为缓解虽然很常见，但只是暂时的。
